Comparison of the Home Care System for the Elderly in Japan and Korea: Towards an Advanced Home Care System
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Journal of Korean Academy of Nursing (2001) Vol. 31, No. 7 Comparison of the Home Care System for the Elderly in Japan and Korea: Towards an Advanced Home Care System Jeung-im Kim, RN, PhD1, Sachiyo Murashima, PhD, RN, PHN2 The purpose of this study is to provide the directions for the further development of the home care services in Korea, through comparison of the home care system and visiting nursing activities for the elderly in Japan and with those of Korea. The results of this study were summarised as follows: The major difference between the two countries was that Japan emphasised the development of home services by visiting nurse service stations (VNSS), especially in the community. In contrast, Korea has emphasised provid- ing hospital based home care services and assuring the quality of services through the preparation of home care nurses before beginning services. And many elderly in Korea have used a public health center when they have health problems. According to the result, the establishment of a VNSS system and activation of a public health center in the com- munity must be considered as the direction to advance home care systems for the elderly. Key Words: Home care; Elderly; Korea; Japan toward a home care system (HCS) for the elderly more INTRODUCTION pressing and has triggered the need for changes to make the health care system more available and more conve- The number of elders in the population is increasing all nient in both countries. over the world; it first occurred in Europe, and now also The most prominent change of the care environment has become a reality in Asia. Coping with ageing and in Japan is that the “Home” has been accredited as a changing the social system appropriately is one of the field in 1994, and home visit service is now covered by big issues in the world today. health insurance. In Korea, home care has been provided Japan and Korea are both Asian countries located in from 1990 at the public level guaranteeing health care to the far-eastern part of Asia. Both confronted the ageing the elderly at home. And it also “home” has been ac- of their societies earlier than other Asian countries. The credited as a field in April 2000 (Medical law, 2000). percentage of elderly people in 1999 in Japan was 16.7 However, there are differences between the systems percent the largest among Asian countries (JHWSA, for home care services in the two countries. Though 1999a). In Korea, it was seven percent in 2000 (KNSO, home visiting nursing was started at the hospital level, it 2000), a point had reached by Japan in 1970. Korea is has been expanded to the community level in Japan, projected to be an ‘Aged Society’ by 2022 (KNSO, while Korea has advocated home care at the hospital lev- 1997). el as a problem solving strategy. These differences reflect This rapid change has made the importance of moving differences in the social, cultural and demographic char- 1. Department of Women’s Health Nursing, School of Nursing, College of Medicine, Soonchunhyang University 2. Department of Community Health Nursing, Graduate School of Medicine, The University of Tokyo, Corresponding author: Jeung-im Kim, PhD, RN. Assistant Professor, Department of Nursing Soonchunhyang University Tel: 8241-530-1357 Fax: 8241-574-3860 E-mail: [email protected] Received September 3, 2001 ; Accepted December 21, 2001 Kim et al. Comparison HCS Japan and Korea 1167 acteristics of each country but there is still a need to find vere disability to patients who then need care for ADL. the directions to provide home care services. This report is aimed to provide the directions for the 2. Health Care Law for the Elderly and Development further development of the home care services in Korea, of a Visiting Nursing System through comparison of the home care system and visit- To improve the level of welfare for the elderly in ing nursing activities to the elderly in Japan and Korea. Japan, the Welfare Law for the Aged was created in 1963, in which the roles of home-helper, nursing home METHODS and special nursing home were addressed. But the num- ber of elderly who occupied hospital beds increased To compare the differences and similarities in each rapidly. People over age 65 occupied 46 percent of all country, a review was done of official materials such as hospital beds and had a 50-day average length of stay Health and Welfare Statistics, the Health and Welfare (Ikegami & Campbell, 1995). This rose to 63.5 percent White Paper, Social Indicators, and literature on commu- in 1996 (JHWSA, 1999a). The reason for the increase nity health nursing related to the care of the elderly and was that elders and their families preferred hospitals to to welfare services. For clarity, pertinent information is welfare institutions. This is the so-called social hospital- tabulated and includes; health care policy and social wel- ization of the elderly (Tatara, et al. 1993) and it in- fare facilities for the elderly. creased the cost of health care for the elderly. In order to reduce social hospitalization, the Japanese RESULTS government developed measures for both institutional care and home care on both the welfare side and the 1. General Characteristics health care side. On the health care side, the Health and The average life expectancy in Japan is higher than any Medical Service Law for the Aged (HMSLA) enacted in other country in the world (KNSO, 2000). The life ex- 1983, enabled visiting nursing services from hospitals to pectancy in Korea is also becoming longer, it was 71 be paid through the insurance system. Through a revi- years for men and 78.6 years for women in 1998 sion of the HMSLA in 1992, the Visiting Nurse Service (KHWWP, 2000). Although Japanese live longer than Station (VNSS) was established in 1992 as a new re- Koreans, the differences have narrower over the past 20 source in the community. The VNSS made it possible for years, from 10 years in 1985 to 4 years in 1998. nurses to become heads of health care organizations, a The number of elderly living with one of their children truly innovative act for nursing in Japan (Murashima, et decreased from 79 percent in 1980 to 54.4 percent in al. 1998 a). 1995 in Japan (JHWSA, 1997), but it is still a large pro- To promote health and welfare services for the elderly, portion. It was 58.3 percent in Korea in 1998 (KIHASA, the Japanese government started the Gold Plan in 1990 1998). The average number of people per household has (It was named as Gold Plan to mean Ten-year Strategy decreased to 2.79 in Japan and 3.22 in Korea in 2000. on Promotion of Health and Welfare Services for the From these phenomena, it is possible to conclude that it Elderly. It set goals to increase both institutional care will be difficult to provide good care for the well elderly and home care services). The Gold Plan was revised in if only family members provide care. 1994 as the New Gold Plan (JMHW, 2000b), to establish Next, many elderly have a chronic disease for which the VNSS as one of the essential agencies in the commu- they need help. In Korea, 86.7 percent of the elderly nity. Recently, a group home for demented elders was have chronic degenerative diseases and 34 percent have formally introduced under the Gold Plan 21. difficulty in Activities of Daily Living (ADL) (KHWWP In Korea, the Welfare Law for Elderly was enacted in 2000). The proportion of people with dementia has in- 1981, and the law to provide home care was enacted in creased in both countries, to 7.2 percent in Japan, and 1990. At that time the government emphasised hospital- 8.3 percent in Korea (JHWSA 1999 a; KHWWP 2000). based home care and over the past 7 years hospital While the most common causes of death at age 65 years based home care projects have been developed in 44 and over in both countries are malignant diseases, cere- hospitals (KIHASA, 1997a). This has now been extend- brovascular diseases (CVA), and heart diseases (JMHW, ed to hospitals nation wide under the Home Care Law 2000 b; KNSO 2000), CVA also frequently causes se- (Medical Law, 2000). The law included details on home 1168 Journal of Korean Academy of Nursing Vol. 31, No. 7 care services, home care nurse qualifications, definitions The major difference between home care services and of service user, service process and prescription, person- visiting nursing services is that home care is provided to nel for home care, and documentation. Through the law patients who have been discharged from the hospital and home care can be reimbursed through the government contains a major medical component. Visiting nursing insurance program (Table 1). provides rehabilitative and preventive care to people with chronic diseases or disabilities in the community. 3. Home Care Service and Visiting Nursing Service In Japan, there are hospital based home care services In comparison to 1970, care of elderly with chronic and community based home care services. Hospital diseases or disabilities has become a big problem in based home care services are aimed to shorten the hos- modern Japan and will become a problem in Korea in pital stay period and community based home care ser- the near future. The background demographics show vices are intended to care people with chronic diseases that the present informal service is no longer adequate at three level of agencies, that is, ward(Ku in Korea), and formal services must be considered in both coun- health center and VNSS.